Early detection of children at risk for antisocial behaviour using data from routine preventive child healthcare

BACKGROUND: Youth antisocial behaviour is highly prevalent. Young people are usually not willing to disclose such behaviour to professionals and parents. Our aim was to assess whether child health professionals (CHP) working in preventive child healthcare could identify pre-adolescents at risk for antisocial behaviour through using data that they obtain in routine practice. METHODS: CHPs examined a national sample of 974 pre-adolescents aged 8-12 years (response 79.1%), and interviewed parents and children during routine well-child assessments. We obtained data on family background and current health of the child from the CHP; on developmental concerns from parents, and on social and emotional well-being, injuries, and substance use from the children. Antisocial behaviour concerned the adolescent-reported 15 item International Self-Reported Delinquency study questionnaire, among which are 5 items on violence against people. RESULTS: The prevalence of 2+acts of any antisocial behaviour was 21.8%, and 33.9% for 1+acts of violence (10.5% for 2+). Children who were male, had a young mother, no parent employed, recent injuries, poor performance at school or who were bored by school, and who had parental concerns more often reported 2+antisocial acts and 1+violence against people. Detection algorithms on the basis of these variables were moderately able to classify outcomes, with Areas-Under-the-Curves ranging from 0.66 to 0.71. CONCLUSIONS: Data from routine well-child assessment can help CHPs to detect pre-adolescents at risk for antisocial behaviour, but detection algorithms need to be further improved. This could be done by obtaining additional information on factors that are associated with antisocial behaviour

Group based prenatal care in a low-and high risk population in the Netherlands: a study protocol for a stepped wedge cluster randomized controlled trial

Background. CenteringPregnancy (CP) is a multifaceted group based care-model integrated in routine prenatal care, combining health assessment, education, and support. CP has shown some positive results on perinatal outcomes. However, the effects are less obvious when limited to the results of randomized controlled trials: as there are few trials and there is a variation in reported outcomes. Furthermore, former research was mostly conducted in the United States of America and in specific (often high risk) populations. Our study aims to evaluate the effects of CP in the Netherlands in a general population of pregnant women (low and high risk). Furthermore we aim to explore the mechanisms leading to the eventual effects by measuring potential mediating factors. Design. We will perform a stepped wedge cluster randomized controlled trial, in a Western region in the Netherlands. Inclusion criteria are <24 weeks of gestation and able to communicate in Dutch (with assistance). Women in the control period will receive individual care, women in the intervention period (starting at the randomized time-point) will be offered the choice between individual care or CP. Primary outcomes are maternal and neonatal morbidity, retrieved from a national routine database. Secondary outcomes are health behavior, psychosocial outcomes, satisfaction, health care utilization and process outcomes, collected through self-administered questionnaires, group-evaluations and individual interviews. We will conduct intention-to-treat analyses. Also a per protocol analysis will be performed comparing the three subgroups: control group, CP-participants and non-CP-participants, using multilevel techniques to account for clustering effects. Discussion. This study contributes to the evidence regarding the effect of CP and gives a first indication of the effect and implementation of CP in both low and high-risk pregnancies in a high-income Western society other than the USA. Also, measuring factors that are hypothesized to mediate the effect of CP will enable to explain the mechanisms that lead to effects on maternal and neonatal outcomes. Trial registration. Dutch Trial Register, NTR4178, registered September 17th 2013

Clustering of Socioeconomic, Behavioural, and Neonatal Risk Factors for Infant Health in Pregnant Smokers

Background: Tobacco smoking is a major cause of morbidity and mortality, including during pregnancy. Although effective ways of promoting smoking cessation during pregnancy exist, the impact of these interventions has not been studied at a national level. We estimated the prevalence of smoking throughout pregnancy in the Netherlands and quantified associations of maternal smoking throughout pregnancy with socioeconomic, behavioural, and neonatal risk factors for infant health and development. Methodology/Principal Findings: Data of five national surveys, containing records of 14,553 Dutch mothers and their offspring were analyzed. From 2001 to 2007, the overall rate of smoking throughout pregnancy fell by 42% (from 13. 2% to 7. 6%) mainly as a result of a decrease among highly educated women. In the lowest-educated group, the overall rate of smoking throughout pregnancy was six times as high as in the highest-educated group (18. 7% versus 3. 2%). Prenatal tobacco smoke exposure was associated with increased risk of extremely preterm (≤28 completed weeks) (OR 7. 25; 95% CI 3. 40 to 15. 38) and small-for-gestational age (SGA) infants (OR 3. 08; 95% CI 2. 66 to 3. 57). Smoking-attributable risk percents in the population (based on adjusted risk ratios) were estimated at 29% for extremely preterm births and at 17% for SGA outcomes. Infants of smokers were more likely to experience significant alcohol exposure in utero (OR 2. 08; 95%CI 1. 25 to 3. 45) and formula feeding in early life (OR 1. 91; 95% CI 1. 69 to 2. 16). Conclusions: The rates of maternal smoking throughout pregnancy decreased significantly in the Netherlands from 2001 to 2007. If pregnant women were to cease tobacco use completely, an estimated 29% of extremely preterm births and 17% of SGA infants may be avoided annually. © 2009 Lanting et al

The association between perceived social support and parenting self-efficacy among parents of children aged 0-8 years

Strengthening social support has been recognized as a potentially effective strategy to enhance parenting self-efficacy, but empirical evidence is limited. This study examined the association between perceived social support and parenting self-efficacy.Data of 647 parents of children aged 0-8 years, gathered in the CIKEO cohort study in the Netherlands, were analysed. Data were collected between October 2017 and December 2019. Multivariable linear regression models were used to examine the association between social support and parenting self-efficacy. The mean age of the participants was 33.8 years (SD = 4.9); 94.9% mothers. At the start of the study, 15.1% parents perceived low to moderate social support. Parents who experienced lower levels of social support at the start of the study reported lower parenting self-efficacy at follow-up (β: 0.13; 95% CI: 0.05, 0.21), independent of potential socio-demographic confounders. Experiencing an increase in perceived social support during the study period was associated with an increase in parenting self-efficacy (β: 0.15; 95% CI: 0.10, 0.21). Our findings indicate perceived social support is associated with parenting self-efficacy among parents of children aged 0-8 years. Future longitudinal studies need to confirm our findings and may examine which social support interventions are effective in strengthening parenting self-efficacy.</p

Evaluation of effectiveness of (elements of) parenting support in daily practice of preventive youth health care

Background: The number of interventions to support parents is growing. The level of evidence regarding these intervention varies. In this paper we describe a study that aims to assess the effectiveness of specific 'elements' within such parenting interventions for families with children up to 7 years. A naturalistic effect evaluation will be applied. Study questions are: 1. What is the exposure of parents to (elements of) parenting interventions in the daily practice of preventive youth health care? 2. What are the associations between the exposure to (elements of

Comparing three short questionnaires to detect psychosocial dysfunction among primary school children: a randomized method

BACKGROUND: Good questionnaires are essential to support the early identification of children with psychosocial dysfunction in community based settings. Our aim was to assess which of three short questionnaires was most suitable for this identification among school-aged children METHODS: A community-based sample of 2,066 parents of children aged 7-12 years (85% of those eligible) filled out the Child Behavior Checklist (CBCL) and - randomly determined - one of three questionnaires to be compared: the Strengths and Difficulties Questionnaire with Impact Supplement (SDQ), the Pediatric Symptom Checklist (PSC) and the PSYBOBA, a Dutch-origin questionnaire. Preventive Child Healthcare professionals assessed children's psychosocial functioning during routine health examinations. We assessed the scale structure (by means of Structural Equation Modelling), validity (correlation coefficients, sensitivity and specificity) and usability (ratings by parents and professionals) of each questionnaire and the degree to which they could improve the identification based only on clinical assessment (logistic regression). RESULTS: For the three questionnaires, Cronbach's alphas varied between 0.80 and 0.89. Sensitivities for a clinical CBCL at a cut off point with specificity = 0.90 varied between 0.78 and 0.86 for the three questionnaires. Areas under the Receiver Operating Curve, using the CBCL as criterion, varied between 0.93 and 0.96. No differences were statistically significant. All three questionnaires added information to the clinical assessment. Odds ratios (95% confidence intervals) for added information were PSC: 29.3 (14.4-59.8), SDQ: 55.0 (23.1-131.2) and PSYBOBA: 68.5 (28.3-165.6). Parents preferred the SDQ and PSYBOBA. Preventive Child Health Care professionals preferred the SDQ. CONCLUSIONS: This randomized comparison of three questionnaires shows that each of the three questionnaires can improve the detection of psychosocial dysfunction among children substantially

Use of the Pediatric Symptom Checklist for the detection of psychosocial problems in preventive child healthcare

BACKGROUND: Early detection and treatment of psychosocial problems by preventive child healthcare may lead to considerable health benefits, and a short questionnaire could support this aim. The aim of this study was to assess whether the Dutch version of the US Pediatric Symptom checklist (PSC) is valid and suitable for the early detection of psychosocial problems among children. METHODS: We included 687 children (response 84.3%) aged 7–12 undergoing routine health assessments in nine Preventive Child Health Services across the Netherlands. Child health professionals interviewed and examined children and parents. Before the interview, parents completed an authorised Dutch translation of the PSC and the Child Behavior Checklist (CBCL). The CBCL and data on the child's current treatment status were used as criteria for the validity of the PSC. RESULTS: The consistency of the Dutch PSC was good (Cronbach alpha 0.89). The area under the ROC curve using the CBCL as a criterion was 0.94 (95% confidence interval 0.92 to 0.96). At the US cut-off (28 and above), the prevalence rate of an increased score and sensitivity were lower than in the USA. At a lower cut-off (22 and above), sensitivity and specificity were similar to that of the US version (71.7% and 93.0% respectively). Information on the PSC also helped in the identification of children with elevated CBCL Total Problems Scores, above solely clinical judgment. CONCLUSION: The PSC is also useful for the early detection of psychosocial problems in preventive child healthcare outside the USA, especially with an adjusted cut-off

Parents' concerns about children are highly prevalent but often not confirmed by child doctors and nurses

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to assess the prevalence in the general population of parents' concerns about the development of their child, to identify groups at risk and to assess the association between parents' concerns and professional judgement.</p> <p>Methods</p> <p>We obtained cross-sectional data on a Dutch nationally representative sample of children aged 14 months, 3 3/4, 5–6 and 8–12 years within the setting of routine well-child visits provided to the entire population. A total of 4,107 participated (response rate 85.3%). Data were about concerns that parents reported by questionnaire before the visit regarding behavioural and emotional problems, developmental delay, consequences of disease and contact with peers that needed professional assistance, and about the assessment of these domains by doctors and nurses during the visit. Moreover, we obtained data on parent-reported psychosocial problems using the Infant-Toddler Social and Emotional Assessment and the Child Behavior Checklist.</p> <p>Results</p> <p>Of all parents, 49.3% reported some concerns and 8.7% reported frequent concerns, most frequently on child behaviour. Frequent concerns were most likely to refer to young children, children from labour immigrant families, with fathers of medium educational level and in low-income families. The prevalence rates of professional-assessed parenting problems were much lower than parent-reported ones. The rates of psychosocial problems were highest in the case of shared concerns, but also higher if parents expressed concerns that were not confirmed by professionals.</p> <p>Conclusion</p> <p>A very large proportion of parents of young children have concerns regarding their child, but agreement on these concerns with child health professionals is relatively low.</p

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat